Prevent a Heart Attack: A His and Hers Guide

Intro

The idea that men and women are different is certainly not news. One popular book even suggests that we come from different planets.

But research suggests that it's more than plumbing and light years that separate us: Our wiring is different too; in particular, that set of wires and pumps known as the cardiovascular system. When we asked leading heart doctors to tell us how you can attack-proof your heart, they nixed a one-sex-fits-all plan in favor of this "his and hers" approach.

But they also asked us to remind you of one way that we're all alike: Heart disease is the leading killer of both men and women. So share this article with the heart that's dearest to you.

Her Plan: No More Queen of Denial

One out of every three women currently under 40 will eventually develop heart disease; more than 450,000 women of all ages died from it in 2004--11 times as many as died from breast cancer. And almost 40 percent of all women in the U.S. live with heart disease. Didn't know that? You're not alone.

"In the past, many doctors didn't know that heart disease was a major cause of death in women, let alone the leading one," says Marianne J. Legato, MD, a professor of clinical medicine at Columbia University College of Physicians and Surgeons in New York City. "Although awareness and treatment have improved somewhat, especially in large cities, the death rate from a first heart attack is twice as high in women under 50 as it is for men1 of the same age."The bottom line: It's up to you to ask for more tests or seek another opinion if you feel that your doctor is dismissing your concerns, risks, or symptoms.

Think Down With Cholesterol
Aim for a total cholesterol of less than 150 milligrams per deciliter (mg/dl), an LDL (bad) of 130 mg/dl or less, an HDL (good) of 45 mg/dl or higher, and triglycerides of less than 150.

"For women, a low HDL is much more predictive of heart disease than a high total cholesterol," says Debra Judelson, MD, medical director of the Women's Heart Institute at the Cardiovascular Medical Group in Los Angeles. "HDL over 60 mg/dl is a positive protector against heart disease," adds Dr. Legato. It may edge your total cholesterol up, but you're still protected against heart disease if your total cholesterol/HDL ratio is 4.0 or less.

Dr. Judelson suggests that you ask your doctor to tack on one more measurement to your regular cholesterol test: lipoprotein (a), a protein strand that's attached to bad cholesterol molecules. When researchers from the Framingham Heart Study tested these levels in more than 3,000 women, they found that participants with lipoprotein (a) above 30 mg/dl doubled their risk of heart disease.[pagebreak]Rate Your Risk
In addition to abnormal cholesterol, you're more likely to develop heart disease if you have these risk factors:

Smoking (ups the odds at least two- to fourfold--more if you take birth control pills)

Diabetes (raises your risk four to six times)

Blood pressure higher than 135/85

Family history of early heart disease

Premature (before age 38) menopause (either naturally or through removal of the ovaries)

Overweight

Sedentary lifestyle

Take the Test
Don't settle for the treadmill test, where you simply walk on a treadmill while your blood pressure and heart's electrical activity are measured. "Although it's a good starting point for men, a treadmill test is counterproductive for women because it produces so many false positives and false negatives," says Dr. Legato.

So where do you begin? With an exercise echocardiography, also known as a stress echo test. While you're on a treadmill, a machine translates sound waves into pictures that show your heart's size, shape, movement, and pumping ability.Redesign Your Diet
A low-fat diet is appropriate for most women, but certain women with a low HDL level can actually increase their risk for heart disease from cutting back on all fats. Most women (and men) will improve their health with a Mediterranean-style diet consisting of lots of fruits and vegetables, with most of the fat coming from olive oil, canola oil, olives, avocados, and nuts.

Olive oil raises good HDL and lowers your risk, says Stephen Devries, MD, director of the Heart Center at the University of Illinois in Chicago. (Prevention recommends that you limit total fat to 25 percent of daily calories, with no more than 7 percent as saturated fat.)

Because diabetes increases the risk of heart disease more for women than men, you should use whole grain carbohydrates such as whole wheat bread and brown rice rather than refined ones such as white bread and white rice, says Walter Willett, MD, chairman of the department of nutrition at the Harvard School of Public Health.

In his study of more than 64,000 nurses, Dr. Willett and his colleagues found that those who ate large amounts of refined carbohydrates doubled their chances of developing type 2 diabetes, while those who consumed mostly whole grains didn't raise their risk at all.[pagebreak]What about HRT?
Doctors think that women have heart attacks later in life than men because estrogen protects them until menopause, says Dr. Legato. But in recent years, hormone replacement therapy (HRT), taken by millions of women to reduce menopausal symptoms and protect their hearts, was dealt a series of blows. In the 1990s, several studies found that estrogen actually increased deaths in women who already had heart disease.

Then, in July 2002, the largest study of its kind--The Women's Health Initiative (WHI)--found that not only did HRT not prevent heart attacks, it actually increased a woman's risk for heart attack, stroke, blood clots and breast cancer. The government, which funded the study of more than 160,000 postmenopausal women, told the participants to stop taking the pills.

In October 2004, researchers sifting through the WHI results found that HRT doubles a woman's chances of developing dangerous blood clots, with the highest risk for overweight women or those over 60. On the strength of this evidence, most doctors are now hesitant to prescribe HRT, especially to women who have risk factors for any of these conditions.No Excuses!
In a recent study, women cited low self-esteem as their biggest barrier to a heart-healthy lifestyle, says Lori Mosca, MD, PhD, director of preventive cardiology research and education at the University of Michigan in Ann Arbor.

And how are you going to break free? "Work on becoming more optimistic," suggests Maryann Troiani, PhD, a psychologist in Barrington, IL, and author of Spontaneous Optimism (Castlegate, 1998). "Optimism and confidence go hand in hand."

She suggests ridding your vocabulary of negative words such as "try" and "but" because they don't give you a sense of commitment to your goal. Talk more to cheerful people and less to unhappy ones. "We feed off of each other's emotions," she says. And walk tall rather than shuffle your feet. "If you look the part and talk the part, chances are you'll feel the part," says Dr. Troiani.

Recognize the Symptoms
"In women, the signs of a heart attack can be very different than they are in men," says Lynn Smaha, MD, clinical cardiologist and former president of the American Heart Association. Instead of crushing chest pain, you may have lighter chest, stomach, or abdominal pain; nausea or dizziness; shortness of breath; heart palpitations; fatigue; and weakness.

If you experience these symptoms, Dr. Judelson advises that you immediately chew a full-strength (325 mg) aspirin (it'll significantly improve your survival rate if you are indeed having a heart attack; if not, it won't hurt) and head to the ER immediately.

And if the docs say that they can't find anything wrong? "Don't let them dismiss you until you've received a thorough evaluation, including an electrocardiogram," says Dr. Judelson. "I've had too many patients who were sent home with a clean bill of health from the ER who indeed had heart disease."[pagebreak]

His Plan: Stop Being the King of Denial

One out of every two men currently 40 and under will eventually develop heart disease; more than 410,000 men died from it in 2004--13 times more than died of prostate cancer.

"You may think that it's the other guy who will get heart disease," says Kenneth Goldberg, MD, director of the Male Health Center in Dallas. "But all my patients with heart disease thought it was going to be the other guy. At least open yourself up to the possibility that it could happen to you. And then work as hard as you can to prevent it."

Think Down With Cholesterol
Shoot for a total cholesterol of less than 150 milligrams per deciliter (mg/dl), an LDL (bad) of less than 130 mg/dl, an HDL (good) of 45 mg/dl or higher, and triglycerides of less than 150.

The most important number in that equation is LDL. "In men, studies show that a high LDL increases the risk of developing heart disease more than a low HDL or high triglycerides, and treatment of LDL is most effective in reducing cardiac risk," says Debra Judelson, MD, medical director of the Women's Heart Institute at the Cardiovascular Medical Group in Los Angeles.Rate Your Risk
An abnormal cholesterol level is not the only tip-off that a heart attack may be in your future, says Stephen Devries, MD, director of the Heart Center at the University of Illinois in Chicago. Consider these other clues:

Smoking (increases your risk at least two- to fourfold)

Diabetes (doubles your risk)

Blood pressure higher than 135/85

Family history of early heart disease

Overweight

Sedentary lifestyle

Take the Test
"I tell people to take charge of their health. Make sure that you are checked for risk factors and that you get the information you need to lower your individual risk," says Dr. Devries.

If you have several risk factors for heart disease, your doctor might recommend a treadmill exercise test (also called a stress test) to get an even better idea of how your heart is working, he says. You simply walk on a treadmill while your blood pressure and changes in your heart's electrical activity are monitored. Based on the results of this test, your doctor may recommend other tests or encourage you to make some lifestyle (exercise and diet) changes.

If your cholesterol and/or blood pressure is particularly high, he may also prescribe medication.[pagebreak]Redesign Your Diet
Trim the fat--especially the saturated kind, advises Dr. Devries. "Most men need to cut back on the fat found in a typical American diet. Meat should be considered a treat, not a part of every meal. Pasta, stir-fries, and fish should substitute for many of the meat meals. In the dairy department, try low-fat milk and cheese," says Dr. Devries.

No Excuses!
When researchers at the University of Michigan in Ann Arbor asked 186 men what stood in their way of achieving a heart-healthy lifestyle, their number one answer was--you guessed it--time (Jour. of Women's Health, vol 7, no 6, 1998).

"In the short term, staying late at the office--instead of hitting the gym or making your doctor's appointment--may seem like it's the best thing to do for your career and family," says Dr. Goldberg. "But you can't climb the corporate ladder or be there for your family from a hospital bed. You need to prioritize your time by putting your health first and foremost."

Recognize the Symptoms
A third of the men who responded to a Men's Health magazine survey said that they wouldn't seek care if they experienced severe chest pain and shortness of breath. Duh!Don't be stupid. If you're having the following symptoms, chew a full-strength (325 mg) aspirin (it'll help break up clots associated with your attack) and get to the hospital ASAP: Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts more than a few minutes or that quickly fades in and out. The pain may spread to the shoulders, neck, or arms, and it may be accompanied by lightheadedness, sweating, nausea, or shortness of breath.

"Remember: The longer you delay getting to the hospital, the more likely that the attack will be fatal," cautions Dr. Goldberg.

Updated April 2007

Karen CiceroKaren Cicero writes about nutrition and health from her home in Bethlehem, PA.

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